The present qualitative study explores local meanings and modes of interpretation of alcohol use among people with problem drinking in the Peruvian Andean highlands. We conducted individual interviews with 19 people in two districts of Ayacucho region identified as having engaged in problem drinking, using McGill Illness Narrative Interview Schedule. Participants articulated multi-layered associations between alcohol and the body, emotions, social relations, and shared cultural practices and understandings. In the explanatory model of physical distress, participants' problem drinking was often identified as one of the perceived causes or consequences. Moreover, many participants shared their experiences of interpersonal difficulties, such as family disintegration, separation from wife/girlfriend, and conjugal infidelity. These experiences resulted in psychological distress, often described by idioms of distress such as "pensamiento" (constant thinking) and "preocupación" (worrying thought), and the engagement with alcohol. At the same time, alcohol use is situated in participants' daily experience, where past and current interpersonal afflictions intersect with persistent economic hardship and injustice at a larger socio-economic level. Alcohol was seen as instrumental in navigating their social relations as well. Decisions and attitudes toward alcohol use in Ayacucho are shaped in the course of searching for opportunities to build, develop, and maintain interpersonal relationships with friends, colleagues, families, and community members. This study illustrates the importance of understanding the patients' life histories in clinical communication as well as the need for social policies to address the socio-economic determinants of hardship and illness that precipitate alcohol use in the south-central Andean highlands of Peru.